1. + Third Parenting Program 25 th May 2013 Weaning

2. + Breastfeeding “formula milk is just a food, whereas breast milk is a complex living nutritional fluid that contains antibodies, enzymes and hormones, all of which have health benefits” Hoddinott P et al. BMJ 2008:336:881-7

3. + Content 1. Weaning : when to start 2. Intestinal flora modification 3. Allergy 4. Three nutritional gaps 5. Take home messages

4. + What is weaning? The introduction of solid foods

5. + WHO = 6 months Europe = 4-5 months Who are we talking about? NEVER BEFORE 4 MONTHS

6. + Common mistakes in Mauritius Timing Elders are wrong most of the time Cheese Salt Honey Gripe water, baby soif. Step by step

7. + Content 1. Weaning : when to start 2. Intestinal flora modification 3. Allergy 4. Nutritional gaps 5. Take home messages

8. + Flore Intestinale

10. + Probiotics

11. + Prebiotics Encourages the development of probiotics

12. + Prebiotiques et probiotiques Protective effect Normalise the intestinal transit. Influenced by nutrition Permanent programing of immune system : allergy !

13. + Allergies Linked with intestinal flora. Roots during weaning period. Permanent programing by the intestinal flora

14. + Content 1. Weaning : when to start 2. Intestinal flora modification 3. Allergy 4. Three nutritional gaps 5. Take home messages

15. + During weaning, babies are more susceptible to infections : “Window of Weakness” at weaning “Environmental challenges” that may bring common childhood infections The Weaning Gap

16. + Infants of 6 to 11 months old are more prone to diarrhea than older children (Kosek, WHO Bulletin, 2003)

17. + Baby’s immune system develops in two ways

18. + There is a Protection Gap starting at 3-6 months of age

19. + Weaning context… a critical period of challenges

20. + Growth during first year of life  Birth weight triples by the end of the first year  Height increases by 50% over the first year and by 25% from 1 to 3 years  Muscle mass grows from a value of 22% total body weight at 3 months to 35% at 5 years

21. + Energy required by age and the amount supplied from breast milk Energy (kcal/day) 1000 800 0-2 m3-5 m Age (months) Energy Gap Energy from breast milk 6-8 m9-11 m12-23 m 600 400 200 0

22. + Pre-school age children Country (2006) Proportion of anemia (Hb <11) 95% C. I. Public health issue? Seychelles 24%7-57Moderate Mauritius 17%13-22Mild South Africa 24%22-26Moderate Madagascar 68%65-71Severe Kenya 69%66-71Severe

23. + Iron deficiency

24. +  Retarded growth and development  Reduced resistance to infection  Irreversible behavioural and mental development

25. + Iron requirements during infancy

26. + Effectiveness of Fortified Infant Cereals

27. + Big nutrition for small tummies…

28. + Take home messages Timing : 6 months (WHO) but... Never before 4 months One new food every 3 days